Study On The Imbalance Of Th1 / Th2 In The Treatment Of Smear - Positive Pulmonary Tuberculosis With Deficiency Of Lung Yin, Yin Huo - Wang And Qi - Yin Deficiency Syndrome

Objective:In order to observe if there is an imbalance of Th1/Th2 cytokines in pulmonary tuberculosis patients and its correlation with CT-scan. By detecting retreatment smear-positive pulmonary tuberculosis and healthy adults peripheral blood Th1/Th2 related cytokines. To provide more effective basis for pulmonary tuberculosis clinical diagnosis、treatment and prognosis. By investigate the regularity between Th1/Th2 imbalance and syndromes, making the TCM syndromes more objective, to provide a scientific basis for the pathogenesis theory of pulmonary tuberculosis.Material and Methods1. Clinical trail group:The study included 58 retreatment smear-positive pulmonary tuberculosis who admitted to The Affiliated hospital of LUZHOU medical college from June 2013 to May 2014, whose syndrome type should respectively meet the primary and secondary symptoms of Yin deficiency type, Hyperactivity of fire due to Yin deficiency type and Qi and Yin deficiency type. The patients (40 males and 18 females) ranged in age from 18 to 67 years with a mean age of 40.05±13.85 years. Pulmonary disease was classified into two groups according to the extent and type of disease as assessed by CT-scan:focus limited group patients presenting unilateral or bilateral involvement of two or less lobes; focus diffuse group with unilateral or bilateral involvement of more than two lobes. Lungs cavity and lungs were not cavity. Erythrocyte sedimentation rate (ESR) normal and abnormal group. According to the different TCM syndromes groups, among them Yin deficiency type, Hyperactivity of fire due to Yin deficiency type, Qi and Yin deficiency type. Only western medicine treatment and combined treatment of traditional Chinese and western medicine in the past.2. Control group:The study recruited 20 healthy adults as control group, which included 14 males and 6 females, ranged from 21 to 62 years old. Mean age 41.05± 13.24.3. Statistical method:The patient’s blood conforms to the selective standard is collected, and then IFN-r, IL-2, IL-4 and IL-10 used cytometric beed array (CBA) measurement. The measurement datas in standard deviation were counted by x±s, which compared by T test. Level was 0.05.All datas were dealed with statistical software of SPSS 17.0.Results:1. compared with healthy adults, pulmonary tuberculosis patients’ peripheral blood IL-2, and IFN-r cytokines higher significantly. There are significant difference between the two groups (P<0.05); Meanwhile IL-4 lower than healthy adults; and there was no statistical difference between the two groups of peripheral IL-10(P>0.05).2. Between the tuberculosis lesions of different extents, Focus diffuse group’s peripheral blood IFN-r lower than focus limited group, while no significant difference between the other cytokines (IL-2,IL-4,IL-10); The patients with cavity lower than without cavity in IL-2 and IFN-r,and there were no statistical differences in IL-4 and IL-10 (P>0.05)3. Compared with the ESR normal group, IL-4 increased significantly in patients with abnormal ESR (P<0.05), and there were no significant difference between the other cytokines (P>0.05).4. IFN-r in pulmonary tuberculosis who combined treatment of traditional Chinese and western medicine higher than only western medicine treatment (P<0.05), and the rest cytokines no statistical differences between the two groups.5.Compared with the Qi and Yin deficiency type, IL-2 and IFN-r were increased in Yin deficiency type and hyperactivity of fire due to Yin deficiency type,IL-4 in Qi and Yin deficiency type higher than Yin deficiency type, The rest of the pairwise comparison all P values greater than 0.05.Conclusion:1. The cellular immunity of retreatment smear-positive pulmonary tuberculosis patients’ decrease, it shows that the Thl-type cytokines of IL-2 and IFN-r which enhance the immunity against tuberculosis decrease while Th2-type cytokines of IL-4 and IL-10 which inhibit the immunity against tuberculosis increase.2. The severity of retreatment smear-positive pulmonary tuberculosis patients is related with the degree of impaired immune function and Thl/Th2 imbalance, Compared with the focus limited group and without cavity group, the focus diffuse and with cavity group are even worse. By detecting the Thl/Th2 imbalance we can detect the activity of pulmonary tuberculosis.3. Thl/Th2 imbalance level is related with syndromes type, the result showed that patients with pulmonary tuberculosis were immunolcompromised, and there are differences between the different syndromes. We can investigate the regularity between Thl/Th2 imbalance and syndromes, making the TCM syndromes more objective, thereby investigate the imbalance of Yin and Yang, to provide a scientific basis for the pathogenesis theory of pulmonary tuberculosis.